Kansas Cellphone

							  The University of Kansas Medical Center

                      Division of Information Resources
               Department of Telecommunications & Networking

                   Cell Phone/Data Plan Request Form

1. The Department of Information Resources is responsible for managing all cellular
   phone/data contracts between the University of Kansas Medical Center and cellular
   providers regardless of the funding source. This policy includes data enabled devices
   including BlackBerry‟s, PDA‟s and other mobile devices.

2. We are required, by an Executive Order of the Governor, to assure that the
   cellular/data plan selected for your use is the minimum plan necessary to meet your
   business requirement. We will work with you to understand your business need and
   to identify the appropriate plan. Please summarize, in the space provided below,
   your rationale for requiring cellular service.

3. State policy prohibits more than minimal personal use of a State-provided cellular
   phone. A detailed listing of your calls (call log) will be provided to you each month
   from the Division of Information Resources. You will need to review the calls and
   certify that they are all business related. In the event some calls are not business
   related you will need to identify the calls on the call log. Note: IRS regulations will
   require the University to report the value of the personal usage as a taxable benefit.

4. If your bill is for the base plan only, we will report as taxable income the pro-rated
   value of the personal use as a percentage of the base plan charge. For example, if
   your base plan is $40 and 10% of the use is personal, we will report taxable income
   of $4.

   If your bill is in excess of the base plan, we will report as taxable income the pro-
   rated value of the personal use (included in the base plan) as a percentage of the
   base plan charge. Additionally, you will need to reimburse us for any personal use
   charged beyond the base plan. Your department will have 15 days following the
   receipt of the monthly call log to process the reimbursement.

5. Cellular contracts cannot include charges for replacement or repair of a lost or
   damaged phone/data device (“insurance”), or any other added services (“roadside
   assistance”).

6. No reimbursement can be offered for business-related use of a personal cell phone.

7. The State Division of Accounts and Reports will periodically audit usage logs.


                    (Signature/Approval required on next page.)
I have read, and agree to, items 1-7 above. (Must initial each line below)


_____ I understand that this device is to be use for business only.

_____ I understand that any unreimbursed personal calls will appear as taxable income on
      my pay check.

_____ I understand that all calls are reviewable under the „Open Records Act‟.
               http://www.kumc.edu/Pulse/policy/KSOpenRecordsAct.html
                         http://www.ksrevenue.org/pdf/kora.pdf


________________________________
Signature

________________________________
Name (printed)

________________________________
Date

_____________________________
Budget Number

________________________________
Cell Phone Number (if existing)

________________________________
Current/Preferred Vendor

________________________________
Type of Device Requested
Cell Phone/Mobile Device/BlackBerry etc.


Rationale for cellular/data service. Please indicate the business case for the
University funded device:




   IR Use Only:                       Request Approved                    Request Denied
The University of Kansas Medical Center

                 Division of Information Resources
          Department of Telecommunications & Networking

            Cell Phone/Data Device Disposition


At your department‟s discretion you may have the option of purchasing
the cell phone or data device and taking it with you when you leave the
University. You will need to reimburse the University for the value of the
device based on a 3-year useful life. (I.E. You leave the University 2 years
after the original purchase of the device. You will need to reimburse the
University for 1/3 of the original cost of the device.)

At your department‟s discretion the phone number may be ported to your
personal cell phone device/carrier if the department no longer needs the
number.

As soon as possible after announcing your resignation you will need to
inform your department that you wish to purchase the device or port the
number and obtain their approval.

Upon approval telecommunications will work with you to port the number
to your designated carrier.

If you do not wish to purchase the device it will remain the property of
your department.